News
Effective June 1, 2026, prior authorization from Evolent is required for radiation oncology services
Date: 02/27/26
Ambetter Health has partnered with Evolent to implement a new prior authorization program for oncology services. This program is intended to reduce administrative burden and support consistent, evidence‑based cancer care.
Effective June 1, 2026, prior authorization from Evolent is required for radiation oncology services provided in a physician office, outpatient hospital, or ambulatory infusion center. Requests will be reviewed using nationally recognized, evidence‑based guidelines.
Prior authorization requirements will apply to Ambetter Health adult members, ages 19 and older, for ordering provider oncology specialties, including
- Gynecology Oncology
- Hematology Oncology
- Medical Oncology
- Neuro Oncology
- Radiation Oncology
- Surgical Oncology
- Urology
Evolent support options
- Real-time authorizations for approvable treatment plans submitted via the Evolent on-line portal at com/provider-portal
- Call 1-888-999-7713 for telephonic support (Radiation Oncology, option 3). Staff are available Monday-Friday, from 7m. to 7 p.m. CST
- Real-time member eligibility verification available in the Evolent CarePro portal, before entering a treatment plan
- Radiation oncologists on staff for clinical discussions with physicians
Ambetter Health approvals issued before June 1, 2026, are effective until the authorization end date. Upon expiration, authorization requests must be submitted to Evolent. If authorization is not obtained from Evolent, claims may be denied. Radiation oncology services/treatment that did not require an authorization prior to June 1, 2026, will require an authorization from Evolent for service/treatment dates on and after June 1, 2026.
Educational sessions will be scheduled beginning in May. For details and registration, please visit go.evolent.com/ambetter-program-changes-june-1-2026. For questions before the educational sessions, contact Evolent at 1-888-999-7713, (Option 6), or by email at providertraining@evolent.com.
We appreciate your partnership and are committed to supporting you throughout the oncology authorization process.